endaily1Subscribe with My Yahoo!Subscribe with NewsGatorSubscribe with My AOLSubscribe with BloglinesSubscribe with NetvibesSubscribe with GoogleSubscribe with PageflakesSubscribe with PlusmoSubscribe with The Free DictionarySubscribe with Bitty BrowserSubscribe with Live.comSubscribe with Excite MIXSubscribe with WebwagSubscribe with Podcast ReadySubscribe with WikioSubscribe with Daily RotationYour body needs some cholesterol. But if you have too much—of the wrong kind—it starts to build up in your arteries. Cholesterol is produced naturally by the liver, and also comes from eating certain foods, such as eggs and red meat. Too much of the bad kind, LDL cholesterol, raises your risk of heart disease, stroke, and other conditions. Low levels of the good kind, HDL cholesterol, can have the same effect.http://feeds.health.com/~r/health/cholesterol/~3/idENysLPobs/0,,20414928,00.html
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You've probably seen certain foods touted as helpful for lowering cholesterol. But how exactly are diet and cholesterol connected?

Let's back up for a minute. In case you need a quick refresher on cholesterol, we all have two natural types in our bodies: HDL, the “happy” or good kind, and LDL, the “lousy” kind. In general, having a high HDL is healthy, while having a high LDL is linked to an increased risk of heart disease.

That’s because LDL tends to clog and harden arteries, whereas HDL carries LDL away from the arteries to your liver to be eliminated. HDL also seems to protect against damage to blood vessels (a major precursor to hardened arteries).

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Then there’s dietary cholesterol, found in animal-based foods. Experts used to think that eating high-cholesterol foods—like egg yolks and shrimp—raised total blood cholesterol levels. Newer research has shown that’s not true.

But what we do know for certain is that other foods (think oats and almonds) can help manage or improve your overall cholesterol profile, and reduce your risk of heart disease. Below are my top five picks for these “cholesterol helpers”—plus easy and tasty ways to eat them more often.

Pulses

Several studies have linked pulses—the umbrella term for beans, lentils, and peas, like chickpeas—to cholesterol reduction. One study, published in the Canadian Medical Association Journal, found that a 3/4 cup of pulses daily lowered lousy LDL cholesterol by 5%. That may not sound like much, but it is a significant drop.

Pulses are truly one of the most versatile food groups, since they can be consumed in both savory and sweet dishes, and are found in many forms, including whole beans, purees like hummus, pulse flours, and products like pulse-based pastas. Add beans to an omelet or whip chickpea flour into a smoothie. Snack on oven-roasted chickpeas or veggies with lentil dip. Add beans or lentils to salads or soups, use pulse noodles in place of wheat versions, and swap all-purpose flour for chickpea or fava bean flour in baked goods. You can even use a hummus or pureed split peas or lentils in place of creamy sauces.

Avocado

In a Pennsylvania State University study, researchers placed overweight adults on a low- or moderate-fat diet, with or without avocado. While the low-fat diet decreased LDL by 7 mg/dL, the moderate-fat diets produced even better results: The non-avocado eaters had an 8 mg/dL reduction in LDL, and the avocado group had a 14 mg/dL reduction.

Avocado goes with just about everything! Spread it on whole grain toast, whip it into a smoothie, add it to an omelet, frittata, or salad. Use it to garnish soups, chili, fish, chicken, beans, hummus, whole grains, or veggies. You can also scoop up guacamole with raw veggies as a snack, use avocado in place of butter in baking, and even whip it into creamy puddings and sauces.

Oats

Oats are a well-known cholesterol-lowering superfood. In one Thai study, people with high cholesterol were given either oatmeal or rice porridge for four weeks. The people who had the oatmeal experienced a 5% reduction in total cholesterol, and a 10% slash in their LDL.

At breakfast, oats can be whipped into smoothies, toasted and sprinkled over fresh fruit, folded into energy balls, layered in parfaits, or added to acai bowls. Of course, there are dozens of variations of overnight oats these days. Plus oatmeal can be served savory as well as sweet. Make it with low-sodium organic vegetable broth instead of water and add shredded zucchini, minced onions, mushrooms, garlic, and Italian herb seasoning. Then top with a sunny side up egg.

You can also use oats to coat baked fish or chicken (in place of breadcrumbs), and as a filler in meatballs, meatloaves, or patties. And oats and oat flour are staples for cookies and healthier baked goods and desserts. I even stir them into melted dark chocolate, along with cinnamon, ginger, and shredded coconut, to make “haystacks.” Another nutritious dessert idea: Fold oats into almond butter with pumpkin pie spice, and use it as a crumble topping for sautéed fruit (aka mock cobbler).

Almonds

A study published in the Journal of Nutrition found that among heart disease patients, consuming just 10 grams of almonds before breakfast (that's about 8 almonds), significantly upped levels of protective HDL. At week 6 the subjects’ good cholesterol values were 12-14% higher, and by week 12 they were 14-16% higher, compared to baseline levels.

In addition to snacking on whole almonds, you can use almond butter and almond flour in many meals and snacks. Whip almond butter into smoothies, add to oatmeal or parfaits, spread it on whole grain toast, or slather it onto sliced fruit. Add savory seasonings—like garlic and fresh ginger—to almond butter for a savory sandwich spread, or thin out the mixture with organic low-sodium vegetable broth to make a sauce for steamed or stir-fried veggies. Crushed almonds or almond flour can also be used to encrust fish or poultry. Plus, sliced almonds make a terrific garnish for any stir-fry, cooked whole grain, or cooked veggie dish.

Almond butter is also the base for many energy ball recipes, and all forms of almonds are staples in baking and desserts. I use almond flour along with chickpea flour to make gluten-free brownies and pumpkin spice muffins. I also love to stir chopped or sliced almonds into melted dark chocolate, along with chopped dried cherries and ginger, to make bark.

Green tea

One strategy for curbing heart disease risk is lowering LDL without also lowering HDL. The good news? Green tea seems to do the trick. A meta-analysis of research published in the American Journal of Clinical Nutrition found that green tea consumption significantly lowered total cholesterol levels (by more than 7 mg/dL), and significantly reduced LDL values (by more than 2 mg/dL) without any effect on protective HDL.

In addition to sipping hot or iced green tea, you can incorporate the brew into your meals. Use chilled green as the liquid in smoothies or marinades. Season warmed tea as a base for soups, or use it to steam brown rice or veggies. Chilled green tea, flavored with fresh ginger, mint or basil, and muddled fresh fruit, is also one of my go-to cocktail ingredients. Try it in a margarita in place of a sugary mixer. Cheers!

Do you have a question about nutrition? Chat with us on Twitter by mentioning @goodhealth and @CynthiaSass. Cynthia Sass is a nutritionist and registered dietitian with master’s degrees in both nutrition science and public health. Frequently seen on national TV, she’s Health’s contributing nutrition editor, and privately counsels clients in New York, Los Angeles, and long distance. Cynthia is currently the sports nutrition consultant to the New York Yankees, previously consulted for three other professional sports teams, and is board certified as a specialist in sports dietetics. Sass is a three-time New York Times best-selling author, and her newest book is Slim Down Now: Shed Pounds and Inches with Real Food, Real Fast. Connect with her on Facebook, Twitter and Pinterest.

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Your body needs some cholesterol. But if you have too much of the wrong kind, it starts to build up in your arteries. Cholesterol is produced naturally by the liver, and also comes from eating certain foods, such as eggs and red meat. Too much of the bad kind, LDL cholesterol, raises your risk of heart disease, stroke, and other conditions. Low levels of the good kind, HDL cholesterol, can have the same effect.
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Blood cholesterol is a risk factor for coronary artery disease and heart attack, so reducing your risk of high cholesterol is a worthy goal. However, the next time you brag that your cholesterol is nice and lowor lament that your number is in the mid-200sknow this: "Your total cholesterol is a pretty meaningless number," says Maureen Mays, MD, a preventive cardiologist and lipid specialist at Oregon Health & Science University in Portland. "Not only does the general public not know this, some doctors don't either."

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Here's why "the number" is so misleading. Total cholesterol is calculated by adding LDL (bad cholesterol), HDL (good cholesterol), and one-fifth of your triglyceride total. "We have been using this formula of adding a bad thing to a good thing and factoring in one-fifth of a bad thing, and it's not useful," Dr. Mays says.

That's one reason 50% of people who have a heart attack have normal cholesterol readings.

Effects of diet and exercise
A smarter way of looking at cholesterol risk is by component. LDL, or bad cholesterol, is very responsive to good nutrition and exercise. The target number is less than 100 mg/dL. It's not uncommon for LDL to swing up by 40% in response to a sedentary lifestyle and a diet high in saturated and other unhealthy fats, according to Dr. Mays.

It can also drop by up to 40% in response to a heart-healthy diet and regular exercise.

One in 500 people has an inherited risk of extremely high LDL and should be put on statins to control their risk of heart disease.

[ pagebreak ]Being overweight can also raise your triglycerides, for which the goal is 150 mg/dL or under. High triglycerides put you at risk for type 2 diabetes, which is a coronary heart disease risk equivalent; this means that if you have diabetes, you have the same risk of dying from cardiovascular problems as someone who already has coronary heart disease.

While increasing age and stress will slightly change your cholesterol panel, "stopping smoking is the best way to raise your good cholesterol," says Dr. Mays.

10 Simple Food Choices for a Healthy Heart

Read how a well-rounded diet full of leafy greens and healthy fats can help lower your risk for heart disease Read more

It is critical for women nearing menopause to maintain a healthy diet and exercise plan to counteract the effects of estrogen loss. Because estrogen suppresses LDL levels, women who reach menopause may notice a surge of bad cholesterol, says Denise Janosik, MD, a cardiologist and professor of internal medicine at Saint Louis University School of Medicine.

Effect of drugs and alcohol
Certain medications, including the steroid prednisone and HIV drugs, can affect your cholesterol panel negatively, so much so that people who are on protease inhibitors for HIV need to be concerned about developing heart disease, and not just AIDS, according to Dr. Mays.

One to two drinks a day is fine for keeping your cholesterol in check. More than that may raise triglycerides because of the high sugar and calorie content of alcoholic drinks. Alcohol also raises HDL slightly, but this increase in good cholesterol isn't as great as that caused by a healthy lifestyle.

Hypothyroidism, too, can result in skewed cholesterol numbers. "If you are fatigued and have sudden weight gain, it is good to have a thyroid screening," says Dr. Mays. "If your thyroid isn't working properly, your lipid panel will make no sense."

Too much LDL (bad cholesterol) can lead to fatty deposits in the blood vessels, which can cause a heart attack or stroke.

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When most people hear "cholesterol" they think "evil." Like most things in life, the reality is more complex; cholesterol can be very bad and very good. On its own, cholesterol is a crucial body component. That's why you make the white, waxy substance (about 75% of the cholesterol in your blood is made by the liver and cells elsewhere in your body). Cholesterol insulates nerve cells in your brain and provides structure for cell membranes.

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"If you want to see what it looks like in a solidified form, go get yourself a can of Crisco at the grocery store," says Gregory Dehmer, MD, director of the division of cardiology at the Texas A&M College of Medicine. "If you open up a can of Crisco, its this white, lard-like substance."

When it comes to heart disease, though, some types of cholesterol are too much of a good thing.

How cholesterol can clog arteries
Not all cholesterol is created equal. It's a fatty substance, so cholesterol can't dissolve in the blood to be carried to where it's needed in the body. "Your body is mostly water, and fat and water don't mix," says Dr. Dehmer.

So cholesterol is packaged into proteins that can shuttle the fatty stuff around your body. One is high-density lipoprotein (HDL, or good cholesterol) and another is low-density lipoprotein (LDL, or bad cholesterol).

What's the difference? LDL can stick to the smooth lining of the blood vessels, where it is absorbed. HDL appears to do the oppositeit actually mops up excess cholesterol and removes it from the blood vessels.

[ pagebreak ]The amount and type of cholesterol in your blood are determined by genetics, age, diet, and exercise. When you eat a diet that's rich in saturated and trans fats, or dietary cholesterol (which is found in animal products such as eggs, milk, and meat), LDL cholesterol levels go up.

"The problem is that many individualsand probably including myselfeat a diet that is very excessive in all the wrong kind of fats, of which we are talking about animal fats and dairy fats, and therefore we get our cholesterol up too high," says Dr. Dehmer.

But when you exercise, HDL cholesterol goes upand that's a good thing. "The bottom line is that there are some people out there who have fairly high levels of HDL cholesterol," says Stephen Nicholls, MBBS, PhD, a research cardiologist at the Cleveland Clinic. "That may drive their total cholesterol to look higher than it actually is in terms of how bad that level is."

How cholesterol affects the heart
If LDL cholesterol is too high, some is absorbed into the artery walls, where it acts like an irritant that triggers inflammation in the body. White blood cells crawl into the artery wall and start "gobbling up fatty particles" in a fruitless effort to heal the damage, says Dr. Dehmer.

The end result is big, fatty deposits in the blood vessels. This causes the vessels to become stiff, narrow, and less responsive to triggers to expand and constrict, a process that ensures a steady flow of life-giving oxygen to the body's tissues. (While you may think of blood vessels as akin to the plumbing in your house, they're more dynamic; they constantly adapt to meet the body's needs.)

If you want to see what cholesterol looks like, go get yourself a can of Crisco at the grocery store.

—Gregory Dehmer, MD, Cardiologist

This process can happen all over your body. If the fatty buildup is in the blood vessels in the legs (a condition known as peripheral arterial disease), you may experience cramping and have difficulty walking; if it's in the penis, you can develop erectile dysfunction; and if it's in the neck arteries, it can cut off the blood supply to the brain and cause a stroke.

The biggest danger, however, is to the heart. The arteries that cover the surface of the heart are particularly prone to clogging. Once fatty plaques clog these blood vessels, blood flow to the heart tissue is reduced. This can cause chest pain, or angina.

If plaque ruptures, a clot can form and cause a heart attacka dramatic decline in the blood supply that causes heart tissue to die. (To find out if youre at risk for having a heart attack, take this test.)

[ pagebreak ]What you can do about bad cholesterol
The artery-clogging process can start early in life. A 2008 autopsy study of adults ages 16 to 64 who died of non-heart-disease-related causes found that 83% had signs of heart disease and 8% had advanced disease. "We're seeing evidence of abnormality of blood vessels and obvious plaque in teenagers," says Dr. Nicholls.

Luckily, there are many things you can do to help prevent this process. "We know that lowering LDL cholesterol, the bad form, is clearly a good thing," says Dr. Nicholls. "The other thing we would highlight is the emerging role of HDL, or good cholesterol, the other player here."

Cholesterol-lowering medication can also help, but you still need to watch your diet and exercise. "You can't just say, 'I'm being treated, so I can therefore not exercise and eat whatever I want,'" says Dr. Nicholls. "It doesn't work that way."

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It's true: Your genes play a big factor in your risk for disease, including high cholesterol. If your mom or dad has high cholesterol, then there's a higher-than-average chance you will, too.

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Thing is, it's not just heredity that can cause high cholesterol. Several lifestyle factors also have a huge impact on your risk. The good news: You can change the choices you make. Here are four mistakes that put you at risk for high cholesterol:

You eat poorly

A diet high in saturated fat—found in meats, butter, and dairy—ups your risk of high cholesterol, as does consuming a lot of foods high in cholesterol, such as beef and full-fat milk products. Eating too many trans fats in packaged baked goods will also raise your risk, though it's becoming tougher to find them; in 2015, the FDA ordered food manufacturers to stop using trans fats within three years. Still, check food labels carefully and steer clear of any that still have "partially hydrogenated oil" listed as an ingredient. Stock up on these five foods that lower cholesterol naturally.

You're obese

Having a body mass index (BMI) greater than 30 means you're more likely to have lower levels of good cholesterol (HDL) and higher levels of bad cholesterol (LDL).

You don't exercise

The more you move, the less likely you are to be overweight or obese—but that's not the only way exercise affects cholesterol. Working out also boosts your levels of HDL cholesterol while increasing the size of LDL particles, which makes them less harmful.

You still smoke

If you haven't quit smoking, what are you waiting for? Lighting up is the leading cause of preventable death in the United States. It's the cause of 90% of all lung cancer deaths, and can even cause cancer in many other parts of the body. As if that weren't enough reason to stop using cigarettes, here's another: smoking lowers your levels of HDL cholesterol and damages blood vessel walls.

Dr. Ed James draws inspiration from his personal experiences with healthy lifestyle changes, having overcome prediabetes and obesity several years ago. In 2011, he founded Heal2BFree to focus on helping individuals and organizations to develop and implement action plans that help close the health disparities gap between blacks and whites.

As a medical student in the late 1980's, I recall being lectured on the importance of medical research. We were told the results of such work would occasionally lead us in directions that were not anticipated. We were also reminded of the importance of analyzing the results critically and comprehensively without bias and following them wherever they might lead. At the time the advice seemed obvious, but in the years since I have come to appreciate such action is not always easy.

I believe that my personal health journey has relevant public health implications and reinforces why we must pay attention to research, even when such results may bring into question current dogma, and even implicate our culture.

A doctor at risk
Several years ago, at the time of my routine physical exam, my doctor informed me that I was prediabetic and my LDL (bad) cholesterol was elevated. I was also obese. As a physician in my mid-40’s at the time, I was quite aware that these were risk factors for premature death. I was feeling much more like a patient--quite vulnerable, concerned, and helpless.

When my doctor gave me the prescription, it was simply for healthy lifestyle changes. He suggested I read The China Study by T. Colin Campbell, Ph.D., which I promptly did, and which thankfully changed my life......for the better. It also provided me with a different lens through which to view some of the greatest challenges that face the medical profession.

Adopting a plant-based, whole foods diet as advocated by Dr. Campbell, and a regular exercise and stress reduction program (as described in publications by Dr. Dean Ornish), I was able to lose more than 50 pounds, "cure" my prediabetes, lower my LDL cholesterol to the normal range, and lower my total cholesterol by approximately 40 mg/dL to under 150. My body inflammation (a risk factor for heart attack), as measured by a lab test called C-reactive protein (CRP), also improved significantly. I was sold.

Changing his health fate
In my family, obesity, type 2 diabetes, hypertension, heart disease, and stroke are frequent co- morbidities and have resulted in much premature death. "The China Study" research clearly demonstrates that these diseases and many others, including cancers that frequently occur in Americans, are preventable in most cases, since diet and lifestyle generally "trump genes." In my opinion, we doctors, although well-intentioned, spend considerable time evaluating patients’ family medical histories, often leaving them with the misconception that their genes hold their likely destinies. Simply put, the diseases that are responsible for the deaths of most Americans can be prevented by a healthy diet and lifestyle in the majority of cases.

The New York Times has referred to "The China Study" as the largest and most comprehensive ever undertaken on the relationship between dietary patterns and development of disease. In rural areas of China, the mean total cholesterol was 127 mg/dL. Rates of chronic disease were generally much lower than in the United States. Interestingly, when these rural Chinese populations migrate to Western countries and adopt our diet and lifestyle, their rates of chronic disease soar to Western levels.

The diet of the rural Chinese in the study consists of mainly plant-based, low-fat, whole foods with some fish, while our Western diet is high in animal-based foods, including milk and dairy, refined carbohydrates, sugar, salt, and saturated fats. The "China Study" research strongly supports that these dietary differences are largely responsible for the much higher rates of heart disease, diabetes, stroke, many cancers, and other chronic diseases in Western cultures, including the United States.

Armed with Dr. Campbell’s research, and that of other researchers, including Drs. Dean Ornish and Caldwell Esselstyn, I set out to "scream from the rooftops" how my personal experience with lifestyle changes strongly supported the China Study research, beginning with my physician colleagues. But......not so fast. While none contested the validity of these studies, most were reluctant to change their personal diets significantly. The research and clinical experience of Dr. Caldwell Esselstyn at the Cleveland Clinic has clearly demonstrated that a total cholesterol of less than 150 reduces one’s risk of a heart attack to virtually zero. Yet most of my physician friends (including cardiologists) do not consider this a reasonably attainable goal for themselves or for their patients.

Why? It is "culturally impossible." It would require a departure from the animal-based foods, high in saturated fats and cholesterol, that comprise the Standard American Diet (SAD). At recent medical conferences that I’ve attended, bacon, sausage, pastries and doughnuts were consumed. In my anecdotal experience over the last 20 years, we doctors generally suffer and die from the same "preventable" chronic diseases as our patients (heart attacks, strokes, diabetes, etc.). I once saw a cartoon of a doctor eating breakfast. In one hand, he held a medical journal whose research concluded that meat contributes to chronic disease. In the other hand, he held a fork with sausage.

The cartoon summarizes the disconnect which I have anecdotally observed. It is my personal observation and conclusion that our reluctance as a medical profession to embrace a plant-based, whole foods diet reflects a general unwillingness to re-examine and critically evaluate our dietary patterns, which are embedded in our culture. Reflecting on our societal imperfections is uncomfortable.

Yet I am optimistic looking towards the future that our approach to chronic disease will change. Continuing medical education programs such as Healthy Kitchens, Healthy Lives (Harvard School of Public Health) and Food as Medicine (Center for Mind-Body Medicine) are now educating more and more physicians and other health professionals about the impact changes in the kitchen can have on chronic disease prevention. When our medical schools begin to engage proactively and impress upon future physicians the need to "walk the talk" with regard to leading healthy lifestyles, we will become better suited as a profession to address the preventive health needs of our patients. ]]>http://www.health.com/cholesterol/61513http://feeds.health.com/~r/health/cholesterol/~3/Qtab4sXS6lU/happy-national-nut-day

Every day is National Nut Day at Health! We usually keep at least four different types of nuts butters on hand at all times (for making the incredible sandwich pictured). And we stock plenty of nuts for eating out of hand as well (so does Molly Sims, who says nuts curbed her post-baby food cravings!).

It makes sense to include a variety, as each tree nut has unique nutritional benefits. For example, walnuts contain a plant-based omega-3 fatty acid; pistachios have lutein and zeaxanthin , carotenoids important for eye health; and almonds are the richest in vitamin E. All are great for heart health and pack healthy fats (especially if you eat them raw, not roasted and salted).

"We know that risk factors for heart disease -- the number one killer of American men and women -- are predominantly modifiable, so this finding gives further support to the notion that early identification and management of these risks is critical," said Dr. Stacey Rosen, vice president of women's health at The Katz Institute for Women's Health in New Hyde Park, N.Y. She was not involved in the new research.

The study was led by Dr. David Bluemke of the U.S. National Institute of Biomedical Imaging and Bioengineering. His team looked at heart scans from more than 1,800 people, ages 45-84, from various ethnic groups who were free of heart disease when they enrolled in the study between 2000 and 2002.

Ten years later, all the patients underwent magnetic imaging scans to assess their heart health. Their average age at that time was 68.

The scans revealed that nearly 8 percent of the participants had scars caused by a heart attack, 78 percent of which had previously gone undetected.

Men were much more likely than women to have this type of scar, nearly 13 percent vs. 2.5 percent, respectively. Other factors associated with a higher risk of heart scarring included smoking, being heavier, higher levels of heart disease-linked calcium deposits in arteries, and the use of high blood pressure medications at the start of the study.

The researchers stressed that a determination of the health impact of these silent attacks "remains to be defined." However, they pointed out that 70 percent of patients who lose their lives to sudden cardiac death show evidence of this type of prior heart scarring.

Dr. Kevin Marzo, chief of cardiology at Winthrop-University Hospital in Mineola, N.Y., reviewed the new findings and said that they support the notion that a routine EKG performed in a doctor's office may only pick up a small percentage of silent heart attacks.

According to Marzo, this means that, for some patients, taking such steps as lifestyle change and cholesterol management to lower heart attack risk may be "necessary despite the reassurance of having a normal EKG in the doctor's office."

The study appears in the Nov. 10 issue of the Journal of the American Medical Association.

TUESDAY, Dec. 1, 2015 (HealthDay News) — About one in every eight American adults continue to have high levels of total cholesterol, while even more have low levels of "good" cholesterol, health officials reported Tuesday.

Although the percentage of adults with high total cholesterol and low HDL ("good") cholesterol declined between 2007 and 2014, roughly 12 percent of Americans still had high total cholesterol and 18.5 percent still had low levels of HDL cholesterol, the report found.

These findings show that while many Americans are working on reaching better cholesterol levels, there is more work to be done, the U.S. Centers for Disease Control and Prevention researchers said.

Lead researcher Margaret Carroll, a survey statistician at CDC's National Center for Health Statistics (NCHS), speculated that more people are having their cholesterol checked and are being treated. Treatments include cholesterol-lowering statin drugs (for example, Lipitor, Crestor or Zocor) and making changes in lifestyle, such as reducing their consumption of trans fats.

But one expert agreed that the progress that has been made is not enough.

"High cholesterol is one of the major contributors for heart disease," said Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles.

The higher the total blood cholesterol level and LDL "bad" cholesterol, the greater the risk for developing heart disease or having a heart attack. Low levels of HDL cholesterol are also associated with increased risk of heart disease, he explained.

"Fortunately, lowering total and LDL cholesterol with certain therapies has been demonstrated to markedly lower the risk of future heart attacks and stroke in both men and women with benefits that greatly outweigh potential risks," Fonarow said.

Using data from the U.S. National Health and Nutrition Examination Survey, the investigators also found that fewer black men had high levels of total cholesterol than white, Asian or Hispanic men. Among women, fewer black women had high total cholesterol than white and Hispanic women, they added.

According to the report, released Dec. 1 in the NCHS Data Brief, black men and women and Asian men and women had higher levels of good cholesterol than did Hispanic men and women.

In addition, black men and women had higher levels of good cholesterol than white men and women, and Asian women had higher levels of good cholesterol than white women, Carroll's team found.

According to the report, there were declines between 2007 and 2014 in the percentage of adults with high total cholesterol, from just over 14 percent to 11 percent. There was also a drop in the percentage with low levels of good cholesterol, from just over 22 percent to slightly under 20 percent.

Although more Americans have lowered their cholesterol, many have not lowered it enough to reduce their risk for heart disease, heart attack and stroke, Fonarow said.

The report defines high total cholesterol as 240 mg/dL or above and low HDL cholesterol as less than 40 mg/dL. But Fonarow thinks those targets are not good enough.

"These [total cholesterol] levels are far above what is needed for ideal heart health and the vast majority of men and women having heart attacks have total cholesterol levels well below 240 mg/dL," he said.

These data do not fully capture the numbers of adults who could benefit from lifestyle changes and cholesterol-lowering statins, Fonarow added.

"All adults 20 to 79 should have their 10-year heart disease risk assessed," he said. "This includes having total cholesterol and HDL levels measured."

THURSDAY, Feb. 4, 2016 (HealthDay News) — Many overweight and obese Americans might be perfectly healthy when it comes to blood pressure, cholesterol, and blood sugar levels—while many thin folks may not be the picture of good health, a new study contends.

Using a government health survey, researchers found that nearly half of overweight U.S. adults were "metabolically healthy."

That meant they had no more than one risk factor for type 2 diabetes and heart disease—including high blood pressure, unhealthy cholesterol or triglyceride levels, elevated blood sugar, or high concentrations of C-reactive protein (a marker of inflammation in the blood vessels).

Among obese adults, 29 percent were deemed healthy—as were 16 percent of those who were severely obese based on body mass index (BMI, a ratio of weight to height).

On the other hand, more than 30 percent of normal-weight Americans were metabolically unhealthy.

The researchers estimate that nearly 75 million Americans would be "misclassified" as heart-healthy if BMI is the only yardstick.

"The bigger picture we want to draw from our findings is that the dominant way of thinking about weight—that higher-weight individuals will always be unhealthy—is flawed," said Jeffrey Hunger, one of the researchers on the study and a doctoral candidate at the University of California, Santa Barbara.

The study, published Feb. 4 in the International Journal of Obesity, is far from the first to find that obese adults can be in good shape as far as heart health. Researchers have debated the "fat but fit" theory for years.

By the same token, studies have shown, being thin is no guarantee of good health.

But, Hunger said, the new findings also help "solidify" the number of Americans who could be mistakenly deemed unhealthy based solely on BMI.

That has potential "real-world consequences," Hunger said. Many larger U.S. businesses offer employee wellness programs, which can include discounts on health insurance premiums for meeting certain goals, such as weight loss. Some employers penalize employees for not participating.

Hunger's team says the U.S. Equal Employment Opportunity Commission has proposed rules that would allow employers to charge workers up to 30 percent of their health insurance costs if they fail to meet certain health criteria, including a specified BMI.

The new study's findings are based on more than 40,000 U.S. adults who took part in a nationally representative federal health study between 2005 and 2012.

Obese men and women were, in fact, the most likely to fall into the unhealthy category: Depending on the severity of their obesity, 71 percent to 84 percent had risk factors for heart disease and diabetes. That compared with 24 percent of underweight and 31 percent of normal-weight adults.

Still, Hunger said, weight is not the be-all and end-all.

"Right now, we have this laser focus on weight when we should be talking about health," he said. "The general public should try to focus on improving their health behaviors—eating well, staying active, and getting enough sleep—and forget about the number on the scale."

But Dr. Gregg Fonarow, a professor of cardiovascular medicine at the University of California, Los Angeles, cautioned that weight does still matter.

He noted that some recent studies have been challenging that idea of "metabolically healthy obesity."

Last year, researchers reported on a long-term study of more than 1 million Swedish men showing that those who were obese but fit—based on a cycling test—were 30 percent more likely to die prematurely than men who were out of shape but thin.

But another study, published in the Journal of the American College of Cardiology, followed 2,500 British adults for 20 years. It found that among those who were obese but healthy at the outset, more than half eventually developed high blood pressure, diabetes and other risk factors for heart disease—often within five years.

It's true, Fonarow said, that at any point in time, obese people may be metabolically healthy. But over the years, obesity takes its toll.

"So individuals who are classified as obese by BMI are at increased risk for a variety of obesity-related ills," he said.

Still, Hunger and his colleagues warn against "obsessing" over weight, which may only worsen heavier people's well-being. Instead, healthy eating and regular exercise should be the focus, rather than BMI, Hunger said.

TUESDAY, Feb. 16, 2016 (HealthDay News) — The once-maligned egg may not be a heartbreaker after all, new research suggests.

Finnish say that even carriers of a gene—called APOE4—that increases sensitivity to dietary cholesterol don't seem to have anything to fear when it comes to the impact of eggs, or any other dietary cholesterol, on heart health.

The findings followed the 20-year plus tracking of dietary habits among more than 1,000 middle-aged Finnish men. All were heart healthy at the study's start, and about a third carried the APOE4 gene, the researchers said.

"It is quite well known that dietary cholesterol intake has quite a modest impact on blood cholesterol levels, and cholesterol or egg intakes have not been associated with a higher risk of heart disease in most studies," said study author Jyrki Virtanen. He is an adjunct professor in nutritional epidemiology with the University of Eastern Finland Institute of Public Health and Clinical Nutrition in Kuopio, Finland.

"However, dietary cholesterol intake has a greater impact on blood cholesterol levels among those with [APOE4]," Virtanen added. "So it was assumed that cholesterol intake might have a stronger impact on heart disease risk among those people. However, our study did not find an increased risk even among those carrying [APOE4]."

Although the study didn't find a link between dietary cholesterol and adverse heart health, the study authors said they weren't able to prove that dietary cholesterol doesn't have a significant impact on cardiovascular disease. For example, one limitation of the study the authors noted was that they only collected dietary information at the start of the study, and had no way of knowing if people's diets changed over time.

Virtanen and his colleagues report their findings in the Feb. 10 issue of the American Journal of Clinical Nutrition. The University of Eastern Finland provided funding for the study, and Virtanen added that there was no funding from egg industry sources.

Finland has a higher-than-average number of APOE4 carriers, with about a third of the population affected, the researchers said. But little is known about whether or not dietary cholesterol intake might affect the hearts of people with the APOE4 gene, the study authors noted.

The new research included people between the ages of 42 and 60. On average, the average dietary cholesterol consumed was 398 milligrams (mg), the study found. No one reported consuming more than one egg per day, on average. One medium-sized egg has approximately 200 mg of cholesterol, the study authors said.

At the end of the 21-year tracking period, 230 of the men had experienced a heart attack. But, the study authors determined that neither egg habits, nor overall cholesterol consumption, had any bearing on heart attack risk or the risk for hardening of the arterial walls.

Virtanen noted that none of the research participants had heart disease or diabetes at the study's launch. "[And] there is some study data from other study populations that egg or cholesterol intakes may increase the risk of heart disease among diabetics," he said. "So our study is not a 'license' to eat as much cholesterol or eggs as one likes."

He added that "there might well be a point when cholesterol or egg intakes may become so high that they may increase the risk of heart disease. However, in our study we could not assess what might be too much, because we did not have enough people with extremely high intakes."

Lona Sandon is a registered dietitian and assistant professor of clinical nutrition at the University of Texas Southwestern Medical Center at Dallas. She said that while "everything in moderation" is the way to go, "people can feel confident about adding eggs, including the yolk, into their daily diet."

"Eggs are a powerhouse of nutrition," she said, "with much of that nutrition found in the yolk. The yolk has vitamin D, essential fats, choline, lutein, zeaxanthin, and more. Good for bones, good for the brain, and good for the eyes. [And] the white is a high quality protein, as well as a source of B vitamins."

Dietary cholesterol doesn't have as much of an impact on blood cholesterol levels as was previously thought, Sandon added. She also noted that the American Heart Association dropped its daily cholesterol limit recommendations years back. Instead, saturated fat and sugars are a more likely culprit in terms of heart disease risk, she said, alongside insufficient exercise.

"[So] an egg a day in the context of a healthy diet pattern does not appear to pose a risk for heart disease or impact dietary cholesterol according to current research," she said. "[But] an egg a day on top of buttery biscuits and gravy is not the way to go."

THURSDAY, Jan. 21, 2010 (Health.com) — One in five teens in the U.S.—and more than 40% of obese teens—have abnormal cholesterol, whether it’s low HDL (good cholesterol); high LDL (bad cholesterol); or high levels of triglycerides, another type of blood fat, according to a new report from the Centers for Disease Control and Prevention (CDC).

The findings suggest that the American Academy of Pediatrics’s (AAP) 2008 guidelines—which recommend more aggressive cholesterol testing and intervention in kids, particularly the overweight and obese—make sense, the authors conclude.

The 2008 guidelines created controversy because, for the first time, cholesterol tests were recommended for overweight or high-risk children as young as 2 years old, and treatment with a cholesterol-lowering statin was an option for children as young as 8 who had bad cholesterol, or LDL, over 190 mg/dL, and who couldn’t lower their cholesterol with diet or exercise. (The previous guidelines said children should be older than 10 before medication was considered, and statins weren’t on the list.)

But adding confusion to the controversy, 2007 guidelines from the U.S. Preventive Services Task Force say the evidence is insufficient for cholesterol testing in children and young adults up to age 20.

The result is that many parents aren’t sure whether they should have their children tested and what to do if a youngster does indeed have high cholesterol. And pediatricians may be testing more children, even those who don’t fit the guidelines.

Testing the right kids?
Kathryn Leslie, 17, is a vegetarian from Albany, N.Y. She prepares Tofurky sandwiches to complement her mom’s vegetable-heavy family meals, and at 5’2” and 110 pounds, she isn’t overweight. So even Leslie’s doctor was surprised to find out she had high cholesterol.

So was her mom, Mary, who notes there’s no family history of heart disease. “My cholesterol is really low and my husband’s cholesterol is normal,” she says. “[Kathryn] is not overweight and eats an extremely healthy diet. It just came out of nowhere.” So why did she have the cholesterol test in the first place? Her mother isn’t sure.

“I didn’t even question why it would be necessary, as she was already getting blood work done anyway, so it was just one more test,” Mary says. “I didn’t ever imagine there would be anything wrong with her cholesterol, so I really didn’t give it much thought.”

In general, experts worry about “just because” tests because they lead to anxiety, unnecessary biopsies (which is a common concern with Pap smears), and potentially harmful and pricey treatments for people who don’t need them. But cholesterol tests are relatively cheap—$50 or so—and can be done if blood is being drawn for other tests, which makes them prime candidates for “just because” testing.

Hard data on children’s cholesterol tests are scant (about 7% of kids were tested prior to the 2008 guidelines). But anecdotal evidence suggests pediatricians are now performing more cholesterol tests.

“There’s more awareness, [because the new] guidelines really got a lot of attention in the media and that trickled down to the medical field,” says Joyce M. Lee, MD, an assistant professor of pediatric endocrinology at the University of Michigan.

Although the 2008 guidelines and the CDC results suggest testing obese children is helpful, Dr. Lee and colleagues recently published a study that suggests that body weight isn’t a strong indicator of which kids will have high cholesterol.

Overall, one-third of adolescents in the new CDC survey were overweight or obese; 22% of the overweight teens and 43% of the obese teens had at least one blood-fat abnormality (as did 14% of teens who weren’t overweight). The CDC survey included 3,125 children and teens ages 12 to 19, who were tested between 1999 and 2006, according to the report published this week in the Morbidity and Mortality Weekly Report.

“It used to be that family history drove who should be screened. Now the recommendations say to include weight as a criterion,” says Dr. Lee. “With obesity being such a problem in [American] children, conditions that we thought were exclusively adult conditions do seem to be prevalent in a small amount of children.”
Next page: Parents confused about what to do

When kids do test positive for high cholesterol, doctors can offer parents advice to eat healthier, exercise more, or potentially take cholesterol-lowering medication, although there is little to no long-term safety data regarding children on such drugs.

After bringing Kathryn to see a dietitian, Mary Leslie says she feels reassured by how well her daughter eats and has put cholesterol worries to the side. “It’s just something we know is there, and we’ll see how it goes,” she says. “I didn’t feel there was anything to do differently except remind her to exercise.”

Dr. Lee recommends that parents have a plan before their child is screened for high cholesterol. “If parents don’t want to abide by the diet, and they don’t want [their children taking] medications, then nothing about the management is going to change, and one might ask, what’s the point?”

Parents like Cassie France-Kelly, a public relations manager from New Market, Md., may end up feeling guilty when a child’s cholesterol is high, especially when they are not sure if they should—or can—dramatically change their children’s diet or activity. “I feel like I’m doing mostly the right things, and yet I have kids with high cholesterol,” she says.

Both France-Kelly and her mother have exceptionally high cholesterol, she says. Her two sons, Mason, 9, and Beckett, 4, are both on the low side of growth charts and are extremely active kids, but their total cholesterol levels are borderline high. France-Kelly says she plans to have her 2-year-old daughter tested next year, but that she would be resistant to medicating any of her children for high cholesterol.

Despite the fact that the AAP said they could be a possibility for children as young as 8 years old, cholesterol medications are not something that most parents want to consider for their kids. In reality, treating children who meet the criteria should mean that less than 1%, or about 200,000, of U.S. kids and teens need to be on cholesterol-lowering medications, according to a February 2008 study.
Statins for kids?
Placing a child on statins is different than prescribing the medications to adults, who typically wouldn’t start a drug regimen until middle age. “If you’re going to start a 10-year-old on it and say, ‘You need to take this for the rest of your life’, there’s some doubt as to whether that would be a good idea,” says Dr. Lee. “People are a bit wary of that, because [statins are] something that could potentially affect growth and development.”

Part of it may also depend on what the doctor prefers. “Some [thought] we need to be aggressive about preventing cardiovascular disease in children,” says Dr. Lee. “Others have [questioned] the long-term side effects and [whether] we should really be prescribing this in kids.”

A more aggressive treatment may be best for certain high-risk children. Autopsy studies do suggest that the first signs of heart disease—fatty “streaks” or accumulation of plaque in arteries—show up in childhood, so screening and treating sooner may prevent complications down the road.

Doctors prescribe statins in children with LDL, or bad cholesterol, levels of over 190 mg/dL with no other risk factors, or in children with LDL levels over 160 mg/dL with risk factors like diabetes, kidney failure, obesity, high blood pressure, or a family history of heart disease.

“Exactly what age to start is slightly controversial,” says Samuel S. Gidding, MD, the chief of pediatric cardiology at the Alfred I. DuPont Hospital for Children, in Wilmington, Del. “But the earlier you treat, the likelier you are to be effective with treatment.”

Statins seem to be relatively safe, says Dr. Gidding. The benefits may outweigh the risks of giving them to children at a young age, especially if cholesterol and, therefore, heart disease risk are very high—although no one really knows what happens when children take the drugs over the course of a lifetime.

“It’s not when you treat, but that you have treated the matter,” says Dr. Gidding. “You actually may want to be treated at an earlier age just so you get that protection of your blood vessels [in case] you have to go off the medication” for reasons that may come up later in life, like pregnancy.

At the very least, early screening can give parents an excuse to teach children how to manage their cholesterol levels from a young age. Doing so may prevent artery damage down the road that could in turn lead to heart disease, especially if cardiac problems run in the child’s family.

“All patients with hyperlipidemia will end up on a low cholesterol diet, and everybody should exercise aerobically, 20 to 30 minutes a day, whether they have high cholesterol or not,” says Richard Lorber, MD, a pediatrician and cardiovascular medicine specialist at the Cleveland Clinic.

However, the guidelines are also not to be taken as set-in-stone rules. “We say we treat children with risk factors and an LDL over 160 of 8 years of age, but each kid is different,” says Dr. Lorber. “Each kid is still evaluated on a personal level.”

It will be a few more years until France-Kelly’s sons are old enough to self-monitor their weight, activity, diet, and cholesterol levels. “I work full-time, so it’s not like I’m there full-time patrolling everything they eat and what they do,” she says. “You wonder if it’s something you did. You feel like you need to work a little bit harder.” ]]>http://www.health.com/cholesterol/teens-have-cholesterol-problemshttp://feeds.health.com/~r/health/cholesterol/~3/-U_F0fanQWk/what-the-yuck-coconut-oil

Roshini Raj, MD, Health’s medical editor and coauthor of What the Yuck?!, fields your most personal and provocative questions.

Q: Should I be eating coconut oil? It seems like the hot new superfood!

A: Not necessarily. Coconut oil is largely made up of a type of saturated fat called lauric acid, which may boost HDL, or good cholesterol, levels. But that’s about all we know for sure. It isn’t as healthy as olive oil’s monounsaturated fatty acids, which can lower total cholesterol, and there’s no real proof that it helps you lose weight or beat cancer, as some claim. Using coconut oil here and there (say, to sauté veggies) probably won’t hurt. Just stay away from partially hydrogenated coconut oil, which packs absolutely-not-good-for-you trans fats.

Got an embarrassing question? Send it to Dr. Raj at whattheyuck@health.com. ]]>http://www.health.com/cholesterol/what-the-yuck-coconut-oilhttp://feeds.health.com/~r/health/cholesterol/~3/BoEYE1aZANk/fda-cholesterol-drug-vytorin-safety-review

The federal agency made the announcement after completing a review of the results of a controversial study, known as the ENHANCE trial. The trial found that the drug—a combination of a relatively new medication, ezetimibe, and an older statin drug, simvastatin (Zocor)—was no more effective than simvastatin alone for treating patients with high cholesterol.

Patients treated with the pricier Vytorin had slightly more narrowing of the arteries—a sign of cardiovascular disease—than the group treated with Zocor, although the difference was not statistically significant.

The FDA said that the study may not have been long enough to demonstrate a benefit, and noted that patients taking Vytorin in the study had a 56% drop in LDL, or bad cholesterol, compared to 39% in those taking simvastatin.

Elevated LDL levels are associated with a risk of heart attack, stroke, and sudden death.

“The results from ENHANCE do not change FDA’s position on the benefits of lowering LDL cholesterol,” a statement released by the FDA said. “Based on currently available data, patients should not stop taking Vytorin or other cholesterol-lowering drugs and should talk to their doctor or other health-care professional if they have any questions about Vytorin, Zetia, or the ENHANCE trial.”

Vytorin is a relatively new way of lowering cholesterol that was first approved by the FDA in 2004. (Ezetimibe on its own is sold under the name Zetia, which was first approved in 2002.) Vytorin lowers LDL cholesterol by blocking its absorption in the intestines, while other drugs work in different ways.

Results of a second trial, known as SEAS, were also released in 2008. It looked at whether Vytorin could reduce heart attack, strokes, and heart-valve surgery in 1,873 people with a condition known as aortic stenosis. It didn’t. However, researchers also found that Vytorin-treated patients seemed to have a greater risk of getting certain cancers—such as prostate, gastrointestinal, and skin—than those treated with a placebo.

In response, the FDA announced that it was taking a closer look at the drug. And a group of researchers at Oxford University analyzed early data from a couple of other big studies (20,000 patients, combined), called SHARP and IMPROVE-IT, which are ongoing.

While there were slightly more cancer deaths in the Vytorin-treated patients in these two trials, it was not statistically significant and most likely due to chance, according to their analysis, which was published in the New England Journal of Medicine.